Knee Replacement Today

Many middle aged men and women develop partial knee osteoarthritis in middle age. In Caucasians, Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment. The erect posture of man and a few other animals contributes to 60% of weight transmission through the inner side of the joint which contributes to wear.

Localized attrition occurs in the beginning as a so called “lesion”. Later it gradually affects the front and inner portion of the inner half of the lower end of the thigh and leg bones (anter- medial wear) leading to partial knee arthritis. This is obvious on standing x rays as meidal or inner space joint space narrowing. Clinically these individuals may be bow legged since childhood.

The standard permanent surgical treatment for osteoarthritis knee has been a total knee replacement. However the ideal candidate for a TKR is a person beyond 65 years, when he can live out the life of an artificial joint which is about 15 years. Clearly someone in their fifties is not suited for a TKR as his/her life span would exceed that of the joint and he would need a revision knee replacement later on.

Surgical alternatives include an osteotomy and a Uni condylar knee replacement. In an osteotomy, the thigh or leg bone is divided and re aligned so that the abnormal weight bearing axis is normalized. Pain relief is provided for a period of up to 10 years but is not total. An osteotomy is the logical operation for patients with bow legs and knock knees in the working class whose work demands would wear out an artificial joint. It is not the right procedure when there is no deformity.

A unicondylar or partial knee replacement substitutes the worn half of the joint with prosthesis. The bony resection is restricted to the affected half alone sparing the outer half and the patella unlike a total knee replacement. The operation can be done by a minimally invasive technique sparing the quadriceps muscle. The pre requisites are that the one half alone must be worn as seen on x- rays and the anterior cruciate ligament should be intact. The technique of insertion is demanding but the rewards to the patient are numerous. Shorter hospital stay, quicker recovery, small incisions, no blood transfusion, less pain, less cost (vs. TKR) and better function (squatting, kneeling, climbing stairs) are the much acclaimed benefits. The knee feels more natural as sensations carried by the ligaments are intact.

The Oxford unicompartmental knee is a representative type and is a mobile bearing uni knee. It replicates the function of the meniscus. The wear rates are low. Survivorship analysis is 98% at 15 years.

Advantages of partial knee replacements
1) minimally invasive surgery- Since the surgery involves a small exposure to see the affected half alone, surgeons can make the incision smaller, producing less post operative pain and smaller scars
2) less blood loss- Since the surgery is minimally invasive, less blood loss occurs.
3) Faster rehabilitation- Patients can stand up and walk on the same day, squat by week one and return to work earlier.

Recently implants have been introduced which replace only two compartments. This is the Journey Deuce prosthesis which replaces the patello-femoral and medial compartments alone, leaving the lateral compartment untouched.

In the US uni-compartmental knee replacements are making resurgence after a revival in the 1990’s.

These innovative knee replacement procedures are available in India. Baby boomers and young patients with partial knee arthritis lacking Mediclaim or Medicare can now fly to India and have their surgery performed in hospitals with international standards.

Dr. A.K. Venkatachalam, MS, DNB, FRCS (UK), MCh. (Liverpool) has worked with leading Knee surgeons in the UK, Belgium and Dubai earlier. He is affiliated to the Chettinad health city & Kamakshi memorial hospital in Chennai. Recovery from surgery is no longer a painful ordeal as expert anesthetists provide effective anesthesia and pain relief to inpatients. The intensive care unit is monitored by alert physicians round the clock and multi specialty referrals are readily available. There are well qualified physiotherapists to help you recover quickly from surgery.

Our track record

We have had the pleasure of treating patients from the USA, UK, Bangladesh and these numbers are increasing. Knee replacements are performed using the most modern techniques and prostheses. Amongst others the following procedures are routinely performed.

When I speak with other orthopedic doctors, one thing is clear-hip and knee replacement surgeries are on the rise. As the baby boomer generation grows older, demand is growing for these increasingly common surgeries, according to a study presented at the American Academy of Orthopaedic Surgeons’ 2006 annual meeting.

It’s obvious that the baby boomers are not so willing to give up their active lifestyle and leisure pursuits, so hip and knee replacement is going to be more prevalent as time goes on! So the question for many over the age of 55 is:

Is Surgery For You?

When people suffer from severe osteoarthritis, hip or knee replacement is often the best option to stay active longer. In over 70% of patients, implants replace joints that are damaged or worn out due to osteoarthritis. But many also have the same surgery performed due to fractures, injury trauma or rheumatoid arthritis. Although the average age of patients is 71 years old, the trend seems to be leaning toward younger and younger patients.

Undergoing a hip or knee replacement is a major decision for you and your doctor, so it may help to know that 82% of 1,001 patients surveyed by Consumer Reports were “very satisfied” or “completely satisfied” with their results.

As I tell my patients, however, recovery doesn’t happen overnight and may be painful. Of the people surveyed, the majority was able to cease taking pain medication after two months, but 12% were still taking it one year after surgery.

It is encouraging to know that 90% of patients could do everyday activities after one month. At the same time, it is important not to push your body too hard. In fact, one-third of hip patients and one-quarter of knee patients were unable to walk half a mile one year after their surgeries. While most people have success with replacement surgery, there is a small chance of infection, and complications, like weakened muscles and legs of unequal length, can occur.

Are There Less Drastic Alternatives?

It is true that a standard replacement gives most people the best possible results, but some alternatives are available:

Hip resurfacing - This procedure can help even severe arthritis sufferers by employing a smaller implant and removing less of the bone than standard replacement surgery.

Knee Osteotomy - Best for young, active patients, this surgery shifts pressure off of the weakest part of the joint. It is an option for people whose arthritis is located on only one side of the knee.

Partial knee replacement - This is a choice if you have limited osteoarthritis and involves resurfacing only one compartment of the knee.

Although hip or knee replacement-or the alternatives-is a big decision, it is important not to wait too long. If you have pain that makes it difficult to sleep and perform everyday tasks, and doesn’t respond to pain medication, you should see an orthopedic surgeon who will help you decide what course of action to take.

The good news is that joint replacements are improving, so chance of success is high, and patients can enjoy many years of freedom from aches and pains. There is no reason why you shouldn’t make your golden years as active and fulfilling as possible.

I had a knee replacement completed in 1999 in Tampa, Florida. I was 44 years old at the time and had injured the right knee from a previous motorcycle accident. I was informed by my orthopedic surgeon that weight training will be out of the question once the knee is replaced at least with my right leg.

You are usually instructed to either swim or bicycle for instance as these are low impact activities that will not place stress on the components. For most knee or hip replacement patients that will be fine as most candidates for a replacement will be over 65 years of age.

We are however in this day and age seeing more joint replacement surgeries with younger people. The baby boomers are coming of age and joint disease is becoming more common. Younger patients tend to be more active as well and will find it difficult to curb previous activities.

Knee and hip components have a come a long way since 1999 however, they still are not designed for high impact activities like running for instance. I advise after a knee replacement that once you get the pain to subside and obtain full range of motion again that you get started with a strengthening program with the joint as soon as possible.

Before starting a program remember that you will need to be cleared by your doctor and that is usually 6-8 weeks out depending on the individual and the orthopedic surgeon.

I am a natural bodybuilder and I will admit stopping weight training with my legs would have been hard to do. To keep your legs strong I have found that the leg press found in any gym is a wonderful tool to keep the quadriceps strong along with leg extensions. Keep the weight light work on higher repetitions and you should be just fine.

keeping the calves strong as well is very important and the standing calf raise along with the seated soleus machine will keep the muscles below the knee strong as well. Remember the thighs, hamstrings and calves are there to support the knee as well and you will get more mileage out of the knee replacement if the supporting muscles are kept strong and toned.

Maintaining strong legs will also help and improve your balance after the surgery and will improve your gait pattern as well.

Hit the weights after the surgery, listen to your body and you should be fine providing you have had weight training experience in the past. If you have not been into weight training or lifting get someone competent in the area to instruct you to get you started on the right track.

Return after your surgery stronger then you were before. Weight training will also build muscle which will in turn help you loose some of those unwanted pounds you accumulated before the surgery due to inactivity. The loss of body weight will also buy you more time with the replacement. I have been training with weights on both legs for years now after the replacement without a problem. Strong legs will buy you independence in the years ahead.

The Gender specific or woman special knee is meant to improve overall function after a knee replacement in women. Women constitute 60 percent of patients undergoing a total knee replacement for knee osteoarthritis in India. Until now knee implants used were designed on the average measurements of knee sizes of men & women. The Gender special or Woman special knee is the only knee implant specifically designed for women.

It is based upon findings presented at the meeting of biomedical and biomechanical engineers in the US. It was first introduced in the US in 2006 and has been launched in India in April 2007. Patients have reported a rapid relief from pain and earlier return of function. They needed hospital shorter hospital stays.

Anatomic differences between the two sexes have been acknowledged for long but only recently applied to design of orthopedic implants says the Surgeon. The gender knee is based on the anatomical facts that the thigh bone or femur in women is narrower from side to side, the knee cap rides on a more oblique line and the lower end of the front of the thigh bone is less prominent.
The surgical technique is not significantly different.

The new knee prosthesis can be implanted through the highly successful technique of minimally invasive or Less invasive surgery in which the incision is only 4- 5 inches long. This woman knee prosthesis also allows high flexion. Post operative pain is significantly reduced and hence patients can be discharged from hospital within a week.

Women who have undergone this gender knee replacement are very satisfied with the result at one year of follow up.

Dr. A.K. Venkatachalam, MS, DNB, FRCS (UK), MCh. (Liverpool)has worked with leading Knee surgeons in the UK, Belgium and Dubai earlier. He is affiliated to the Bharathiraja hospital. Recovery from surgery is no longer a painful ordeal as expert anesthetists provide effective anesthesia and pain relief to inpatients. The intensive care unit is monitored by alert physicians round the clock and multi specialty referrals are readily available. There are well qualified physiotherapists to help you recover quickly from surgery.

Our track record

We have had the pleasure of treating patients from the USA, UK, Bangladesh recently and these numbers are increasing. Knee replacements are performed using the most modern techniques and prostheses. Amongst others the following procedures are routinely performed.

Knee
Total knee replacement- normal and high flexion
Unicondylar knee replacement
Arthroscopic ACL reconstruction
Cartilage surgery
Osteotomy for osteo arthritis and knee cap problem
Fracture
http://www.kneeindia.com/aboutus.asp

Having a knee replacement takes not only certain physical preparation but mental preparation as well. Before having the surgery it is important to have your home laid out for simplicity and easy navigation.

Find a chair that you will be spending a majority of your time in when you arrive home. preferably, its a recliner as you do not want to have your leg in a dependent position where gravity affects the pooling of the blood. Once your chair is designated be sure its of proper height and does not rock. Building a platform prior to surgery to place under the chair is an idea that many have used in the past with great success to raise its height for easier transfers.

Hopefully you have been given an exercise handout prior to surgery to begin preparing your body for the surgery. Completing basic exercises to the affected limb or limbs will greatly assist you in the post-surgical recovery as its known that muscle has memory, and will return to normal function and strength much sooner if exercised in the same manner prior to surgery. The time varies, but 3-5 weeks out should have you prepared and ready following a written exercise program.

Please be sure to have a quality cold pack or other cooling system ready when you get home. Your knee will recover and respond much faster and pain relief will be kept to a minimum with an effective cold pack. Check your local drugstore or better yet a local medical supply will have a larger selection. I see many patients trying to ice down a knee with a small bag of peas and carrots this is something I do not recommend, your knee will need better coverage than that.

Have your meals prepared or have someone that will be staying with you for the first 10 days to 2 weeks home, as the last thing you want to do is stand on your surgical leg in the kitchen preparing meals, believe me it will only take one episode of meal preparation to understand the importance of having food prepared or someone assisting you with it.

Make sure you bring home your compression stockings that are issued at the hospital, many leave them and find they would have come in handy at home. The stockings are to curb edema and to prevent DVT. Take your pain medication as prescribed as well. Many try to get off the pain medication too soon only to be very uncomfortable you will need the pain medication anywhere from 4-6 weeks out from surgery.

And most of all, complete the exercises that have been prescribed by your therapist. your final outcome will be only as good as the time you put into the exercise program. You will see a big change in your overall condition within 6 weeks after surgery if not sooner remember, everyone is different and what your neighbor did and experienced down the street will be different from your experience.